On Infection Prevention & Control

Experiences, case studies and news about infection prevention and control.

Providing Behavioral Health Care Via Telehealth

04/30/2020

Robert Campbell, PharmD, director, clinical standards interpretation for hospital/ambulatory programs

Editor’s Note: This blog post is part of The Joint Commission’s daily communication on issues relevant to organizations managing the COVID-19 pandemic. The full list of FAQs is available here.

What are the requirements for providing behavioral health care services via telehealth?

The Joint Commission’s requirements that address credentialing verification of telehealth providers are found in the Human Resource Management (HRM) chapter of the Comprehensive Accreditation Manual for Behavioral Health Care (CAMBHC) at HRM.01.02.01. 

Note: HRM.01.02.01 includes credentialing requirements for ALL staff who provide care, treatment, or services for the organization, including those receiving pay (for example, permanent, temporary, and part-time personnel, as well as contract employees), volunteers, and behavioral health profession students. When employed by the organization, licensed independent practitioners are considered staff. CAMBHC does not include specific requirements on credentialing during a disaster, therefore, the requirements outlined in HRM. 01.02.01 would apply.

Licensed Independent Practitioners (LIP) CURRENTLY credentialed and privileged by the organization, who would now provide the same services via a telehealth link to patients, would not require any additional credentialing or privileging. The medical staff or leadership determines which services would be appropriate to be delivered via a telehealth link. There is no requirement that ‘telehealth’ be delineated as a separate privilege. Behavioral health providers are expected to practice within the scope of their license/certification or registration and comply with state laws and regulations for providing telehealth services during the emergency or disaster as required by HRM.01.01.03 EP 2. and LD.04.01.01 EP 2. 

Telehealth Products  
During the COVID-19 nationwide public health emergency, covered health care providers may use non-public facing applications that allow for using telecommunications technology for two-way, real-time interactive communication.  Providers are encouraged to notify patients that these third-party applications potentially introduce privacy risks, and providers should enable all available encryption and privacy modes when using such applications. 

Public facing applications (such as Facebook Live or Tik Tok), should NOT be used in the provision of telehealth by covered health care providers.

Remote Telehealth Communications  

Services that a covered health care provider, in their professional judgement, believes can be provided through telehealth in the given circumstances of the current emergency may be provided.  This includes and is not limited to diagnosis or treatment of:

  • COVID-19 related conditions
  • mental health counseling for individual or groups
  • psychiatric consultations, 
  • psychological evaluations
  • adjustment of prescriptions

For new opioid treatment program (OTP) patients that are treated with methadone, the requirements of an in-person medical evaluation will remain in force.  Patients with opioid use disorder starting methadone are also not permitted to receive escalating doses for induction as take-home medication.

Requirements for Behavioral Health Organizations that change their settings to include telehealth services during the state of emergency or disaster:

The Standard Applicability Process (SAP) chapter in the CAMBHC lists standards that apply to various setting(s), service(s), and program(s), and specific population(s). During the state of emergency or disaster:

 

  • The only setting standards that apply to organizations which are CLOSED during the disaster and SOLELY providing Telehealth services directly to patients at home, are the technology-based setting standards.  In addition, organizations are required to comply with all the standards that apply to various service(s), and program(s), that are operational and as listed on their electronic application. 
  • The organizations providing telehealth services to patients at one or more of their locations by a practitioner who is at a location remote from the patient and is communicating with the health care professional who is treating the patient using telecommunication system, are required to comply with all the standards that apply to various setting(s), service(s), and program(s), that are operational and as listed on their electronic application in addition to standards that apply to Technology-Based setting.

The organizations should notify their account executive of any such change no later than 60 days after the state of emergency or disaster has ended.

Licensure Requirements for Providers who use Telehealth

Licensing for telehealth varies from state to state. According to HealthIT.gov, most states require a provider to be licensed to practice in the originating organization’s state, while others require the healthcare provider to have a valid license in the state where the individual served/patient is located.

CMS announced a waiver allowing doctors to furnish telehealth and other services using communications technology wherever the patient is located, including at home, even across state lines.

However, it’s only legal to practice across state lines if the state where the patient resides has also waived restrictive practice acts limiting transfer of license. The Federation of State Medical Boards provides a list of the states that have modified in-state licensure requirements for telehealth in response to COVID-19.

Telehealth Licensing and Scope of Practice Resources

Governmental telehealth policy changes during COVID-19
The Telehealth Resource Center’s website answers several frequently asked questions about Licensure and Scope of Practice. 
The American Telemedicine Association’s State Telemedicine Policy Center compiles state-specific information about telemedicine policy.

Telehealth COVID-19 Resources
American Counseling Association provides COVID-19 State Resources with compilation of state actions regarding Telehealth regulations, insurance commission data, Medicaid guidance and additional updates.
SAMHSA Resources and Information related to COVID-19 for individuals, providers, communities and states across the country.
FAQs on Telehealth and HIPAA during the COVID-19 nationwide public health emergency

Robert Campbell, PharmD, is director, Clinical Standards Interpretation Hospital/Ambulatory Programs and director, Medication Management. Prior to these roles, he served as the pharmacist for Clinical Standards Interpretation in the Division of Healthcare Improvement at The Joint Commission. Campbell also surveys as a field representative for The Joint Commission in the Hospital Accreditation and Critical Access Hospital Accreditation Programs and is a reviewer in the Medication Compounding Certification Program. Prior to joining The Joint Commission, Campbell worked in health care organizations and held leadership positions with oversight responsibilities for performance improvement, accreditation readiness, risk management, infection control and medical staff services, as well as inpatient and outpatient pharmacy services.